Location:Liverpool School of Tropical Medicine, Liverpool, UK, University of Malawi, Blantyre, Malawi

Malawi has a high incidence of bacterial meningitis among adults. Currently, mortality exceeds 50%. More effective locally appropriate treatments are an urgent priority.

Glycerol has been shown to reduce mortality by approximately 50% in children with bacterial meningitis in South America. If similarly effective in adults, glycerol would represent a cheap, locally produced adjuvant therapy appropriate for use in this setting. It has been used as a food additive and for medicinal and cosmetic purposes for many years.

The proposed study is a proof of principle placebo controlled trial of glycerol adjuvant therapy in bacterial meningitis in Blantyre, Malawi. All patients will be treated with antibiotic therapy according to the national guidelines. In addition, patients will receive glycerol or water orally or via nasogastric tube. The primary endpoint will be mortality, with measures of morbidity as the secondary endpoint.

This study will provide the first information on the efficacy and optimum dosage of glycerol in meningitis in adults. The data will be used in the design of a subsequent larger multi-centre trial in four tropical research centres that will include patients with acute and chronic meningitis.